Saved By The Bell – The Lost Health Care Episode

The House Republicans’ latest attempt to repeal and replace the Affordable Care Act/Obamacare would turn several federal requirements into state options. This is both bad politics and bad policy.

As others have noted, Republican attempts to repeal and replace Obamacare have made the law more popular. The individual elements of the Affordable Care Act have always had broad support (many were Republican ideas). The least popular part of the law was always the word “Obama,” and he’s gone. The irony that Republicans are in the uncomfortable position of attacking popular Republican policies is not lost on health care policy watchers.

In this new draft Congress gives away more of its own power by allowing states to apply for various waivers to the current law. The waivers could be for relief from community rating requirements, relief from health benefits packages, and relief from rules preventing insurers from charging older Americans more for health insurance than they charge others. Such provisions are popular and as such states are likely to leave them in place (allowing insurance companies to jack up costs for seniors is not a political winner).

Congress giving states the power to ignore Congress when it comes to health care continues a trend of the institution shedding responsibility.Congress has been surrendering more power to the executive and has been outsourcing its thinking to lobbyists for years. Rather than own the hard work of governing and explaining the challenges and choices to voters, Members of Congress continues to find ways to make headlines while making others do their work. One result, not surprisingly, is decreased public faith in Congress. Congressional inability to solve problems has led advocates to increasingly focus on states and increasingly ignore Washington. Should this health care proposal pass, that trend will continue.

This new plan is the sort of political strategy high school students would dream up (maybe a plot twist in the lost sequel to the “The Election”episode of Saved By The Bell — wouldn’t be the first time Saved By The Bell has predicted our current politics). It is also politically dicey. Publicly attacking popular parts of the ACA is a questionable political strategy. Further, those to whom the buck is being passed — governors and state legislators — could respond by punishing Members of Congress at the polls. One response could be attacks that lower voters’ opinion of incumbents and Congress in general — “Congress once again failed the American people, leaving to us to clean up their mess…”. This, of course, creates a political opening for clever and ambitious politicians (most state and local elected officials are ambitious, and many are clever) — “Congress passed the buck to the state and we fixed their mess again, it’s time for those of us who know how to actually accomplish things to go to Congress…”

In the meantime, Congress is ignoring real changes to the ACA that could be both politically popular and benefit the American people. There is no shortage of ideas on how the law could be improved in ways that make good policy and good politics — regular readers know my view, the former head of the Centers for Medicare and Medicaid Andy Slavitt offered a number of suggestions. Other ideas abound.

Rather than pursue this amendment, which is uncertain at best, poses political perils for its promoters, and would continue to erode the power and standing of Congress, Members of Congress should do what the American people most want them to do: govern. Find elements of the Affordable Care Act that need fixing and improving, then build a bi-partisan coalition to do it. At worst, nothing in the law changes which would probably be fine with the American people. At best, Congress would actually make policy progress, which usually makes for good politics.